Every organization requires good leadership to ensure successful team building (Marquis & Huston, 2003) and effective management of the organization (Perra, 2000) as well as personal fulfillment. In the past, health care system was a bureaucratic organization that was locked by hierarchical models type management (Thyer, 2003). However, due to advanced in technology, information and communication; changes in politics, demographic, social economics status and patient’s expectation toward health care system, traditional task- orientated, routine and habitual nursing management style no longer able to meet the evolving health care system. Therefore, it is crucial for current health care worker especially nurses to integrate leadership in health care management to meet the needs of contemporary professional nursing practice and consumers’ requirement and expectation (Sofarelli & Brown, 1998).
As senior medical assistant with 10 years working experiences. Currently I am practicing at a hospital based orthopeadic department in Northern Hospital. Our unit comprises four units, orthopeadic wards, Trauma operating theater, Orthopeadic clinic, Rehabilitation unit and emergency observation room. In fact, through our professional background, as a health worker, we are well trained for the decision making skill to deal with immediate patient care, such as dislocation, polytrauma, polyfracture, fat embolism, compartment syndrome and etc. Leaders have, for the most part, been concerned with orientating the profession to focus upon developing nursing practice (Salvage, 1989). As a senior Medical assistant other than giving services to the client who came to hospital to seek the treatment , I also assign to manage newly qualify staff nurses and medical assistants to makes sure that all the job done by them is following Standard Operating Procedures and helping them to get their opportunity to upgrade their knowledge. These are our new government policy and know as monitoring internship programme. According to Chua (2006) newly graduated nurses are now required to undergo a one year practical before they can earn their Annual Practice Certificate and this is part of the efforts to arrest the decline in nursing standards in public hospitals as health centers.
This paper discussed about leadership quality in my organization when mentoring newly qualified staff nurses and medical assistants. As mention by Charnley (1999) the transition from student to staff nurse has always been seen as a challenging and stressful time in the working life of a nurse. In my view to lead and contributes to the development of an organization and provides professional leadership to the practice nursing team, we must have good knowledge, attitude, skills and capability. As a mentor I have to facilitate personal and professional development through identifying gaps in knowledge and skills, encouraging reflection and providing structure feedback to enable the newly qualified nurses develop and expand their practice with safety and confidence and improve standards of care. According to Clancy (2004) although employers can influence the quality of patient care, it is the qualities of individual nurses which have a more direct effect on the way patients are looked after.
There are numerous texts providing definitions of leadership. Marquis and Huston (2003) defined leadership as a process of empowering beliefs, moving, persuading and influencing others toward a goal mostly without any force or threat. According to Yulk (1998) leadership is commonly defined as a process of influence in which the leader influences others toward goal achievement. Meanwhile Cohen (2004) stated leadership is the best tactic that one can use to motivate others and renew interest in others in attaining goals that are for the good of all.
There are three style of leadership which are autocratic, democratic, and laissez-faire, as cited in Kelly-Heidenthal (2003). Autocratic leadership involves centralized decision making, with the leader making decisions and using power to command and control others. Democratic leadership is participatory, with authority delegated to others. The third style, laisser-faire leadership, is passive and permissive and the leader differs decision making. These approaches are still apparent today (Carvey, 1999), and can be used interchangeably to response to various situations. (Marquis & Huston, 2000).
The autocratic style can be seen as high power tactics over the group leaving very little for others to actively become involved with process changes or improvements. (Mintzberg, 1979) this style is use when the leader tells her subordinates what she want to be done and how she want it done, without getting the advice of her followers. Subordinates behavior is closely controlled through such means as punishment, reward, arbitrary rules and task orientation. According to Fieder (1967) the autocratic leadership style is based on the assumption that the leader knows everything and what is best for their organization. Subordinates cannot be trusted to do what is right for the organization. Because of this, autocratic leadership usually leads to high levels of absenteeism and staff turnover.
The democratic method of leadership style is seen as the most productive within a group setting because this offers chances for their group to become one in decision making with the leader identifying individual strengths or weakness and guides the group with motivating questions and suggestions. However, the leader maintains the final decision-making authority. Using this style is not a sign of weakness; rather it is a sign of strength that your subordinates will respect. According to (Kelly, 2003) the democratic leadership style encourages subordinates participant and professional growth and promotes greater job satisfaction and improved morale.
The laissez-faire style allows the subordinates to make the decision. This French phase means ‘leave it be’ and is used to describe a leader who leaves her colleagues to get on with their work ( Kumar, 2006). It can be effective if the leader monitors what is being achieved and communicates this feed back to her team regularly. However, the leader is still responsible for decisions that are made. This is used when subordinates are able to analyze the situation and determine what needs to be done and how to do it. According to Daft & Marcic (2001) unfortunately, the laissez-faire leadership style can also refer to situations where managers are not exerting sufficient control.
Mentoring the mentorship programmed had given me the opportunity to use several of leadership style to lead the newly qualified staffs to achieve their goal and to enhance the quality of the patient care. Continuous Professional Development activities definitely improved knowledge and skill to assist newly qualified staffs in patients’ health education effectively, to encourage the newly qualified staffs to attend Continuous Professional Development program I use the democratic leadership style. The democratic leadership style encourages each individual to give suggestion and new ideas, and let them to decide whice the activities in Continuous Professional Development they want to attend, each individual feel valued and motivated. I also practice the autocratic style of leadership but on rare occasions especially in maintaining the Standard Operating Procedure. I will guide and coach them to develop their skills and gives them motivation to influence productivity and will provide the good quality of care to the patients.
The current type of leadership is transactional leadership. Transactional leadership categorized as traditional leadership which concernig day-to-day operation in unchanged organizational system (Marquis & Huston, 2003; Lindholm et al., 2000). Transactional leader represent by efficient managers that focus at on hand task, solve immediate problems, communicate clear expectation to their staff and give reward to good performance (Tatum et al., 2003). In transformational leadership, leaders and followers are able to raise each other to higher levels of morality, motivation and productivity (Marquis & Huston, 2003; Lindholm et al., 2000; Spitzer- Lehmann, 1994). Transformational leader value organizational culture (Marquis& Huston, 2003).Therefore, effective communication is crucial for leader and follower to share the goals and culture of the organization (Marquis& Huston, 2003).
The transformational leadership is the preferred model to manage today’s complex and rapid ever changing healthcare environment. Transformational leadership is an empowering leadership style and one which is highly suited to the profession of nursing. Burn (1978) as cited in Kelly-Heidenthal (2003), described a transformational leader as one who empowers others. Empowerment is the process by which we facilitate the participation of others on decision-making and power sharing. Graetz, et al. (2006) described empowerment as redistribution of decision-making to involve employee or worker participation. By educating and motivating staff to practice transformational leadership, eventually the team will mature and create strong team building and high performing working culture. Hence increase health care service standard and promote cost effectiveness for the organization (Thyer, 2003).
A leadership style that is empowering nurse in decision-making enable nursing practices to shift from traditional boundaries to new and effective practices. This is because health care professionals are continuing facing great challenges in dealing with patients with complicated problems. This means that nurses and nursing leaders have to be good decision-makers. However, many nursing leaders in Malaysia are adopting the hierarchal models of leadership styles which limit nurse empowerment in decision-making. This model makes it difficult for nurses to gain confidence in decision-making and skills in assertiveness and negotiations, hence prefer to adopt a submissive approach towards those who control the organizations.
What is the difference between leadership and management? It is a question that has been asked more than once and also been answered in many different ways. The huge difference between managers and leaders is the way they motivate the personal who work with them. Kotter (1990) describes the differences between leadership and management in following way, Leadership is about creating change and management is about controlling complexity in an effort to bring order and consistency. Stated by Bennis & Nanus (1985) managers are people who do things right and the leaders are people who do the right things. Management is defined as the action to plan, organize, direct and control staff (Marriner-Tomey, 1996). According to Allen (1998) a leader used specific skills to inspire the work of others, all leaders are not necessarily managers and all managers are not necessarily leaders, however, to be an effective manager, one must have strong leadership quality and personality. A leader is different from being a manager from the following categories their point of views, actions, goals, motivation and the extent of their authority (Fieder, 1967). According to Swansburg (1996) skill of both managers and leaders are needed for successful operation of any organization. It would easy, if indeed possible, for an organization to achieve their goals if a manager did not know how to lead as well as manage.
According to Grohar (1992), newly qualified nurses have found mentoring to be a useful tool for career development especially at the beginning of their career and specific defining moments such as a change of work roll. Mentoring has been accepted as a guiding of inexperienced subordinates but not at all monitoring result in the growth of the mentee. According to Hanna (1999) the young leader will learn a lot on her own and not be spoon-fed to gain knowledge from someone past experiences.
This topic has attempted to broaden the understanding of the subject of leadership in nursing and to develop the theme that leadership to bridge some of gap between theory and practice in nursing, the development of the leadership, the application of leadership skills is up to us. It can only be gained through actual experience and experimentation.
Actualizing goals in today’s health care arena requires nurse managers to be excellent change agents and role models. Effective leadership in nursing requires skills that are both taught and practically learnt Burns (1978). According to Fielder (1967) the leadership theory a nurse choose should reflect her ideals and be one she can most effectively use. Nurses who assume leadership and management roles need to be creative thinkers, in their work demand and have to oversee that everyone else is fulfilling their duties and the patient care is of the best.
In my view a good management and leadership skills are very important in this current increasing awareness of organization to meet their demands and provide excellent nursing care practices. A good leader will be able to implement effective leadership which will help to achieve unit goal by involvement by unit staffs.